ANCIENT VERSUS MODERN CARE OF THE DYING

It seems obvious that health care in the developed world is radically different in the twenty-first compared to the first century. In ancient times, the patient was certainly the center of attention, and there was little technology and few invasive procedures. Health care of the day relied on natural remedies of all kinds, especially on medicines derived from plant and animal sources, and massage, in all its ancient forms, was a widely used and well-respected treatment. In contrast, modern health care has become high tech and in many cases depersonalizing for the patient and his or her family members. It is often conducted in noisy, busy, and confusing circumstances, and this has special importance for those patients who are terminally ill and approaching the end of life.

A century ago, whether as the result of trauma, disease, or old age, it was common for a person to die at home surrounded by family and loved ones. Typically the atmosphere was quiet, calm, and respectful. Family members themselves cared for the dying relative directly. Physicians of the day attended patients in their home for those able to afford their services, and often pro bono for those who could not. When required, physicians had powerful narcotics at their disposal to relieve patient suffering. Compared to the present day, the available medical options for treatment were greatly limited; however, it can be argued that the simple care of the dying patient was much more personal. This is partly because so few medical options were available and when nothing further could be done, there was little choice for the patient and his or her relatives. In addition, the com-mon practice was for elderly relatives to live with their own family members. Indeed, today it is still the custom in many parts of the world for the eldest son in a family to have the first responsibility for taking care of his elderly parents. In this way, several generations of family members live in the same household. Because life-threatening childhood and adult diseases were rampant, it was not uncommon for a child to experience the death of one or more siblings or parents. In these circumstances, children grew up with direct personal experience of caring for a relative who was dying.

In many parts of the industrialized world, there is a growing tendency for elderly relatives to live alone or with their spouse until they are at the stage where they can no longer take care of themselves, at which point they are admitted to various levels of nursing home care. As the end of a normal life span approaches, illnesses of various kinds are unfortunately very common. At this time, modern medical and surgical procedures can be highly invasive, painful, uncomfortable, and a source of great anxiety for the patient and his or her relatives. In these situations, massage treatment can be especially helpful in easing the suffering of the dying patient and in promoting a caring communication between health care providers, relatives, and the patient. Thus, the caring bond that develops has effects similar to the massage given to a baby or infant (see Chapter 14). In this way, massage has a special role to play at both the beginning and end of life, and, of course, at all times in between.

Increasing medical mechanization and pharmacological advances can contribute to a dehumanizing patient experience. The isolation and lack of physical contact perceived by many patients has encouraged a search for ways to provide closer human contact, such as therapeutic touch and a renewed interest in massage. A wide variety of health care practitioners, with varying levels of training, use massage in providing care for their patients. For patients of all ages, the judicious use of massage can ameliorate the discomfort of invasive techniques and provide a sense of reassurance and caring.

A variety of studies have shown massage to be an effective treatment in the palliative care of the dying (Billhult & Dahlberg, 2001; Birk et al., 2000; Burke et al., 1994; Evans, 1995; MacDonald, 1997; Simpson, 1991; Stevensen, 1995; White, 1988; Wilkinson, 1996). In particular, massage has been shown to be an effective adjunct for the management of the anxiety and pain of terminal illness, especially that caused by cancer (Ahles et al., 1999; Grealish et al., 2000; McCaffery & Wolff, 1992; Pan et al., 2000; Simpson, 1991; Weinrich, 1990; Wilkie et al., 2000; Wolff, 1992).

Another technique that appears to be helpful in palliative care is the so-called therapeutic touch. As mentioned in Chapter 1, this concept is somewhat controversial. Although the name implies a touching technique, the original concept of therapeutic touch does not require the therapist to physically touch the patient. The therapist’s hands move over the part to be treated without making physical contact. Obviously then, the technique cannot have any direct mechanical effect on the tissues. This does not mean that the technique has no benefit: it simply means that it cannot be explained by the accepted mechanical and physiological mechanisms. In fact, the original technique claimed to balance energy fields around the affected parts (Feltham, 1991; Krieger, 1973, 1979, 1981). Obviously, any technique for which the therapist does not have to physically touch the patient is potentially useful, especially for the patient who is hypersensitive. However, it would be incorrect to describe this technique as a form of massage.